With and Without the NHS

(Isaiah 65.19-22, Galatians 5.22-25) Like most of you, I was glued to the television for the opening ceremony of the 2012 London Olympics. I’d more than a passing interest in it because my husband’s godson was performing in the amazing Spectacular, in which we showcased the ‘Best of British’. What did we display with such energy, creativity and humour? Our National Health Service!

The scale of the NHS organization is huge. In 2016, one million people accessed healthcare every 36 hours, and one in 25 of the population was directly employed by the NHS. My mind travels back to my being just over three years old. We lived up the hill in Infracombe, in Devon. Wartime petrol-rationing, meant that he was away most of the month, leaving my mother on her own, in a town where she knew next to no one. I had two younger brothers. One was two years old and the other 10 months old. The baby was born with the umbilical cord round his neck, and developed severe cerebral palsy. Then he caught Meningitis.

My mother, a doctor, was beside herself with agony. She knew that the new medicine, Penicillin, might save her precious baby. But, in wartime, all Penicillin went to the soldiers. My little brother died. My mother, on her own with her remaining two children, was plunged into grief.

That was bad enough. But then, out of the blue, the doctor’s unexpected invoice dropped through our letterbox. It was customary, in those days, for doctors to treat one another’s close relatives for nothing – but this pediatrician sent a huge bill for his share in the dead baby’s treatment. There wasn’t any money. My parents had been missionaries in India, and my father’s current job was poorly paid. We were thrown both into agonizing bereavement and, simultaneously, into what for us was a huge debt.

My parents decided that my mother must return to work fulltime as a doctor, until the bill was paid. My younger brother went to grandparents, and I was sent to a kindergarten boarding school aged three plus – shocked and confused by the chaos and grief in our little family. It left a lasting wound in my life. So, I knew all about life without a National Health Service.

Then, in 1948, when I was ten years old, the amazing NHS was founded by Aneurin Bevan. It stood for three things: to meet the needs of everyone, to be free at the point of delivery and to be based on clinical need rather than on ability to pay.

I trained as a doctor in this expanding, fruitful NHS. I took it for granted that everyone had a right to receive equally fair service. My medical unit performed the first kidney transplant in the UK. Everything, available, to everybody was heady medicine to practice.

When I was 25, John and I moved to Thailand - to fulfill our vocation of working, as missionary doctors, in a country, which had yet to develop widespread medical services. We worked in a remote area. The people were poor, everything had to be paid for; so, as a doctor, you didn’t do a blood test, order an x-ray, admit someone to hospital or operate unless it was unavoidable.

Patients sometimes queued for several days waiting to be seen, and I examined and treated 80 – 100 patients daily. We measured people’s wealth by the number of water buffaloes they owned. The people themselves costed medical treatment by how many buffaloes would have to be sold to pay for an operation, and how many would then be left to work the rice fields, to feed the extended family. We offered the minimal and cheapest treatment possible. Sadly, occasionally we would hear of a child being sent to the city to work as a servant or prostitute to pay hospital bills. So, I experienced life without the NHS, for the second time round.

Then, 16 years later, we returned to the UK and encountered a totally different, highly specialized medical system. It required us, more or less, to retrain completely to work in it again as doctors. And so I trained instead as a psychotherapist, and later for ordination. I couldn’t face this new ever-developing, ever-enlarging and ever-specializing NHS, after Thailand’s limitations.

The NHS has done me proud with seven operations, on my lower legs, making walking possible. I’ve received wonderful care from surgeons, nurses and everyone in the chain to cleaners and caterers. But at the same time, I see an NHS that’s really struggling, and often failing, simultaneously to fulfill all three of its founding principles. You don’t need me to fill you in on the details of this: there’s the so-called ‘postcode lottery’, subtle discrimination on the basis of age, physical health, particular medical conditions, and so on. We’re very aware of the system’s shortcomings. Some of us have been badly hurt, our expectations haven’t been met, our trust is shaky, or has evaporated.

The NHS appeared to offer total care from cradle to grave, and we feel let down, sad, angry and frightened. Might we have to pay in the future? Might the doctor patient relationship become a kind of commercial transaction? Will we land up on the scrapheap, or worse still in a fearful old people’s home resembling a Victorian workhouse?

Today’s NHS is different from that in which I trained as a doctor. Today we’re encouraged to take responsibility ourselves for our illnesses, and to try to prevent, not simply cure them. In the words of Sam Wells, the Vicar of St Martin-in-the-Fields,

‘This unavoidable, but nonetheless culturally challenging,

twofold move – from cure to prevention, and from passive consumer to active partner – is, for the most part, a good development. ‘The most positive thing about it is that it offers a more holistic notion of medicine. The notion of medicine on which the NHS was founded was that medicine was conducted behind a veil by highly skilled experts whose authority could not be questioned and whose powers were almost magical.

‘When one became ill, one was ushered into the world of the experts, who would do all that could possibly done and then, if all went well, return you to the world of the well. ‘The new culture… sees health as primarily our own responsibility, and regards medical professionals and partners and advisers as there to help us sustain healthy habits, rather than rescuers who dramatically intervene when our body arbitrarily and often suddenly goes wrong…’

He adds, ‘In 1948 the NHS became the church. Its hospitals became our great cathedrals, its doctors became our priests, it held the power over life and death, and in a culture where everlasting life seemed less significant and this life in its fullness was becoming the summit of all aspirations, the NHS held the keys of the kingdom…’ [1] The church quietly bowed out of its centuries-long, traditional role of spearheading medical care, from cradle to grave, in our country.

‘Cradle-to-grave’ care is something many of us long for. Some are disappointed that the NHS no longer offers it to us. Some of us are disappointed that the church no longer seems to have this offer. Perhaps we’re looking in the wrong places. It’s God alone who offers this and who can be trusted to care for us, from beginning to end. In the words of our first reading, [2]

‘I will delight in my people; the sound of weeping and of crying will be heard… no more. Never again will there be in it an infant who lives but a few days, or an old man who does not live out his years; the one who dies at a hundred will be thought a mere child; the one who fails to reach a hundred will be considered accursed. They will build houses and dwell in them; they will plant vineyards and eat their fruit. No longer will they build houses and others live in them, or plant and others eat. For as the days of a tree, so will be the days of my people; my chosen ones will long enjoy the work of their hands.’

‘Cradle-to-grave’ care comes from God alone. It is in God we can safely trust. We will not be let down.

[1] Sam Wells, https://s3-eu-west-1.amazonaws.com/smitf/wp-content/uploads/2017/11/13091959/may-22-sw-lod-with-sermon.pdf

[2] Isaiah 65.19-22